Sustaining and Increasing the Benefits of Public Health

Updated October 2014

Public health is the practice of preventing disease and promoting good health within groups of people, from small communities to entire countries. In the current economic environment, public health seeks to improve its effectiveness and efficiency to produce a sustainable health system.

Public health professionals work to prevent population-wide health problems through educational programs, policies, services, regulation of health systems and some health professions, and research. In contrast, clinical professionals, such as doctors and nurses, focus primarily on treating individuals after they become sick or injured. The dramatic achievements of public health in the 20th century have improved our quality of life, increased life expectancy, reduced infant and child mortality, and eliminated or reduced many communicable diseases.

A strong public health infrastructure to prepare for and respond to both acute (emergency) and chronic (ongoing) threats, protects the nation's health. To become more coordinated, efficient and effective, public health must identify and sustain “core” services; increase adherence to national public health standards; coordinate among health departments and other sectors, especially health care; stabilize funding for basic infrastructure and core services; and explore shared services. An NCSL article, A Wealth of Public Health, discusses the public health system and the state legislative role.

A series of Institute of Medicine (IOM) reports from 2010 to 2012 highlight leverage points to improve the public health system and explore its integration with primary care to improve population health. In the April 2012 report For the Public's Health: Investing in a Healthier Future, the IOM identifies “essential ingredients” to renew the public health system:

• Adequate and sustainable funding for governmental public health;
• Reform of governmental public health infrastructure and operations to align spending with need; and
• Using public health knowledge to help improve delivery and quality of clinical care and integrate it with public health’s population-based efforts.

Taking Steps: Public health organizations at the federal, state, tribal, local and territorial levels already are taking steps to increase effectiveness and efficiency. Through its National Public Health Improvement Initiative (NPHII), the Centers for Disease Control and Prevention supports improvements in 74 state, tribal, local, and territorial health departments’ systems, practices, and essential services. Early successes include:

• New Jersey’s faster reporting time for influenza test results from 2–3 weeks to 2–3 days;
• Tennessee’s strengthened public health data system for vital records; and
• Virginia’s consolidation of critical data measures from 119 public health system databases into one real-time user interface serving all offices.

Voluntary Public Health Accreditation, another effort to improve quality and performance of public health departments, was launched in December 2011 supported by the Centers for Disease Control and Prevention and private funding. Their online resources are located at www.cdc.gov/ostlts/accreditation.  Efforts to integrate public health and health care are also becoming more prevalent as public health offers assets such as information on community health status, delivers economical and effective prevention, delineates evidence-based practice guidelines and assists individuals in making healthy choices.

National Center for Health Statistics gathers and maintains a wide variety of health statistics, data sets and reports available for state policymakers and researchers alike. For more information, go to: http://www.cdc.gov/nchs/data/factsheets/factsheet_data_access_and_resources.htm.

Creating Effective State Health Systems - Resources by Topic Area

Accountable Care/Coordinated Care

• Accountable Care Strategies: Lessons from the Premier Health Care Alliance's Accountable Care Collaborative, this Commonwealth Fund report shares the perspectives of hospitals and health systems taking part in the Premier health care alliance’s accountable care implementation collaborative. (August 2012)
• Community Health Teams: Outcomes and Costs, this short chapter (page 408 in this Institute of Medicine report) explains the growing need and proliferation of chronic disease management programs as well as greater opportunities for prevention, better care, and long-run cost savings. (IOM, 2010)
• Healthier by Design: Creating Accountable Care Communities - Accountable Care Communities (ACCs) take the concept of medical homes and accountable care organizations one step further by fostering collaborations borne of shared responsibility among clinical and community sector participants to reform health systems in particular localities. The vision of ACCs are to develop efficient, sustainable model of care that promote health, prevent disease, and improves access to better quality care while containing costs. (Austen BioInnovation Institute, Feb. 2012)
• Partnerships Between Federally Qualified Health Centers and Local Health Department for Engaging in the Development of a Community-Based System of Care - This report provides an overview of several partnership opportunities available to FQHCs and LHDs seeking to improve health outcomes in their community, while promoting cost-effective care. (National Association of Community Health Centers, 2010)
• Strategies for States to Encourage and Fund Community Care Teams - This issue brief outlines the role that community care teams can play in improving the quality and value of health care provided by the states, especially to Med­icaid populations. It identifies strategies that states can adopt to promote the use of multidis­ciplinary care teams and to put sustainable financing in place. (National Governors Association)

Budget/Other Resources

• Average State Public Health Spending Per Person, FY 2010-2011 - NCSL Postcard, July 2012
• Budget Cuts Continue to Affect the Health of Americans (Association of State Territorial Health Officials, March 2012)
• For the Public's Health: Investing in a Healthier Future (Institute of Medicine, April 10, 2012)
• Investing in America's Health: A State-By-State Look At Public Health Funding And Key Health Facts, examines key disease rates in combination with health spending in states around the country. The report concludes that a sustained and sufficient investment in public health and disease prevention is important to improving health and driving down the nation’s health care costs. (Trust for America's Health and Robert Wood Johnson Foundation, March 2012)
• Local Health Department Job Losses and Program Cuts: Findings from January 2012 Survey (National Association of County & City Health Officials, January 2012)
• National Profile of Local Health Departments Profile Study reports and publications (National Association of County & City Health Officials, 2012)
• State-Level Estimates of Cuts to Programs, Budgets, and Workforce (National Association of County &  City Health Officials, July 2012)
• In tight fiscal times, National Public Health Week highlights the return on public health investments  (blog posting by Kim Krisberg, referenced by the National Association of Local Boards of Health, March 2013)

Community Benefit/Needs Assessment

• Community Benefit resources provide information to help local health departments and non-profit hospitals conduct collaborative community health assessments and improvement processes. (National Association of County & City Health Officials NACCHO, 2012)
• Resource Center for Community Health Assessments and Community Health Improvement Plans (NACCHO, 2012)
• Mobilizing for Action through Planning and Partnerships (MAPP), is a community-driven strategic planning process for improving the efficiency, effectiveness and the performance of local public health systems. (NACCHO, 2012).
• How State Health Agencies Can Support Patient Navigators and Community Health Workers - This ASTHO resource highlights the growing importance of patient navigators and community health workers in the healthcare workforce, and showcases successful developments to establish the role of these jobs in various states, territories and regions. It provides examples of ways state health leadership can collaborate and partner to support workforce development, long-term financing mechanisms, establishment of occupational associations and policies that reimburse providers for the services they offer.

Evidence-Based Practices

• The Guide to Community Preventive Services (The Community Guide)  is a resource that assists users in choosing programs and policies to improve health and prevent disease in communities.
• US Preventive Services Task Force (USPSTF) is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."

Public Health Law Resources

• CDC’s Public Health Law Program (PHLP) works to improve the health of the public by developing law-related tools and providing legal technical assistance to public health practitioners and policy makers in state, tribal, local, and territorial jurisdictions.
• Network for Public Health Law

Shared Services

• Centers for Disease Control and Prevention Resources on Shared Laboratory Services - This site includes An Overview of Legal Considerations in Assessing Multijurisdictional Sharing of Public Health Laboratory Services, a resource for public health laboratory directors and their legal counsel as they explore potential legal issues related to sharing testing services with other jurisdictions to strengthen the public health laboratory system. The Overview of Legal Considerations is a companion report to A Practical Guide to Assessing and Planning Implementation of Public Health Laboratory Service Changes.
• Center for Sharing Public Health Services – Rethinking Boundaries for Better health - The Center for Sharing Public Health Services is a national initiative of the Kansas Health Institute with support from the Robert Wood Johnson Foundation. The Center exists to help teams of public health officials and policymakers test and refine ways that public health agencies can share resources and work together to improve their performance. The idea at the heart of the initiative is cross-jurisdictional sharing–the process of reaching across administrative boundaries to share resources, work and results.
• Public Health IT Preparedness- This webinar from NACCHO explores opportunities for local health departments, clinical partners, and federal agencies to increase health IT workforce and technical capacity to achieve public health goals.

Performance/Quality Improvement

• Improving Population Health Outcomes: Creating a Truly Comprehensive Health System (National Academy for State Health Policy)
• Grants to Strengthen Public Health Programs, Infrastructure and Workforce - Affordable Care Act: State Action Newsletter, Sept. 2011
• State Health Improvement Planning (SHIP) Guidance and Resources (Association of State and Territorial Health Officials)
• Quality Improvement (ASTHO)
• National Quality and Performance Initiatives (ASTHO)
• Performance Management and Quality Improvement (CDC)
• Office for State, Tribal, Local and Territorial Support (OSTLTS) (CDC)
• National Public Health Improvement Initiative (NPHII) - Through this program, the CDC supports state, tribal, local, and territorial health departments to make fundamental changes and enhancements in their organizations and implement practices that improve the delivery of public health services.
• Health System Measurement Project (Department of Health and Human Services)
• For the Public’s Health: The Role of Measurement in Action and Accountability (IOM, December 8, 2010)
• National Voluntary Accreditation for Public Health Departments - The goal of the national accreditation program is to protect and improve the health of the public by advancing the quality and performance of all public health departments in the country — local, state, territorial, and tribal. Accreditation using the Public Health Accreditation Board (PHAB) standards and measures are the framework for evaluating a health department’s processes and services, their outcomes, and progress toward specific goals and objectives.

Public Health and Clinical Care

• Menu of State Public Health Department Accreditation Laws - CDC Public Health Law Program, October 2014
• Public Health Department Accreditation - LegisBrief, October 2013
• Primary Care and Public Health Working Together - NCSL LegisBrief, August 2012
• CDC's Primary Care and Public Health Initiative - Linking Primary Care and Public Health through Residency Program Partnerships - Through this  initiative, CDC is collaborating with clinical educators to develop public health-focused educational resources for delivery in residency training programs.
• Community Transformation Grants - NCSL Postcard, May 2012
• Community Transformation Grants - The Centers for Disease Control and Prevention’s Community Transformation Grants (CTG) program supports community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes. By promoting healthy lifestyles, especially among population groups experiencing the greatest burden of chronic disease, these grants will help improve health, reduce health disparities, and control health care spending.
• Integrating Primary Care and Public Health, Supplement to the American Journal of Public Health, Supplement 3, Vol 102, No. S03 (June 2012)
• Primary Care and Public Health: Exploring Integration to Improve Population Health (Institute of Medicine, March 28, 2012)
• Funded by the Robert Wood Johnson Foundation and the Kresge Institute, The Hilltop Institute’s Hospital Community Benefit Program published a brief, Hospital Community Benefits after the ACA: Partnerships for Community Health Improvement. It illustrates that partnerships between hospitals, local communities and public health agencies can help leverage limited public health and health care dollars, while addressing specific social, economic and environmental factors that affect community health. (February 2012)
• Campaign for Public Health Foundation three-page pictorial, Where is Public Health? (January 2013)

Systems Change

• National Prevention Strategy - NCSL LegisBrief, July 2012
• National Prevention, Health Promotion and Public Health Council - The Council members are cabinet secretaries, chairs, directors, or administrators of federal departments. By including officials from across the federal government, the Council may benefit from a wide variety of perspectives and inter-agency collaboration. The Council is pursuing a more holistic approach to community health that address a number of factors that influence our health–housing, education, transportation, the availability of quality affordable food, and conditions in the workplace and the environment. Recently released is the National Prevention Council Action Plan Implementing the National Prevention Strategy, which outlines more than 200 prevention and wellness steps the federal government is taking to implement the National Prevention Strategy.
• NewPublicHealth.org - A new digital meeting space sponsored by the Robert Wood Johnson Foundation to spark an ongoing conversation about public health challenges, opportunities, evidence, solutions and innovations. RWJF invites and encourages active participation.
• For the Public's Health: Revitalizing Law and Policy to Meet New Challenges - The Institute of Medicine examined the legal and regulatory authority for public health activities, identified past efforts to develop model public health legislation, and described the implications of the changing social and policy context for public health laws and regulations. (IOM, June 21, 2011)
• Transforming Public Health: Emerging Concepts for Decision-making in a Changing Public Health World - The Transforming Public Health project indicates the need for health departments to develop policy goals; use integrated data sets; communicate with the public and other audiences to disseminate and receive information; mobilize the community and forge partnerships; cultivate leadership along with organization, management, and business skills; and protect the public in the event of an emergency.
• State Roles in Delivery System Reform - This report outlines the evidence in health system reforms, as well as the opportunities for governors to lead these efforts. With contributions from experts in the health care policy field, the report provides tools available to states to create a more efficient and effective health care system. (National Governors Association)
•  A Healthier America 2013: Strategies to Move from Sick Care fo Health Care in Four Years, from Trust for America's Health.

Resources

NCSL
A Wealth of Public Health State Legislatures Magazine, December 2013
Public Health Department Accreditation - LegisBrief, October 2013
Primary Care and Public Health Working Together - LegisBrief, August 2012
Sustaining and Increasing the Benefits of Public Health - Public Health Herald Newsletter, Aug. 2012
Average State Public Health Spending Per Person, FY 2010-2011 - Postcard, July 2012
National Prevention Strategy - LegisBrief, July 2012
Community Transformation Grants - Postcard, May 2012
Grants to Strengthen Public Health Programs, Infrastructure and Workforce - Affordable Care Act: State Action Newsletter, Sept. 2011

Article References
10 Essential Public Health Services - National Public Health Performance Standards Program (NPHPSP); CDC, Dec. 2010
American Public Health Association’s “What is Public Health? Our Commitment to Safe, Healthy Communities” - American Public Health Association, 2012
Association of Schools of Public Health’s “What is Public Health?” - Association of Schools of Public Health, 2012
Healthy People 2020 – Public Health Infrastructure Chapter- Healthy People 2020, Aug. 2012